I'm just about to head off to a meeting with some of the information people in my hospital about the plans for SNOMED implementation, so it seems opportune to make a few related comments.
- I guess in general, some kind of coding system is great (indeed essential if you are going to do anything sophisticated), but they come with some gotchas. If you plan for these gotchas from the outset your life will be easier.
- The entity-relationship model starts relatively simple: You have concepts. These concepts have labeled, directed many-to-many relationships with each other. Terms have many to many relationships to concepts.
- No single coding system will ever meet all your coding requirements. Ever. Full stop.
- You either have to severely restrain (or constrain) clinicians ability to express the ideas they want to express OR accept that there will always be the same idea represented in the different ways. Accept the latter, or accept that clinicians are going to insist on free text instead.
- Coding systems will contain errors and ambiguities - even if infinite resources were going into coding system maintenance, evolving medical knowledge would cause this semantic drift.
- Becarful with concept labels - too long and your users will hate you, too short and they become dangerously ambiguous.
- You WILL encounter instances where different craft groups become very passionate about their use of a particular term being the correct one, and the other craft group having it wrong.
- Coding system semantic network classification trees will become integral parts of any decision support logic, so as your coding system is updated then the conclusions reached by your decision support system may change (often I'd suspect in ways you don't appreciate)
- There is some jargon it is worth being across:
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